Remifentanil versus Propofol/Fentanyl Combination in Procedural Sedation for Dislocated Shoulder Reduction; a Clinical Trial
Archives of Academic Emergency Medicine,
Vol. 7 No. 1 (2019),
,
Page e10
https://doi.org/10.22037/aaem.v7i1.289
Abstract
Introduction: Procedural sedation and analgesia (PSA) is a fundamental skill for every emergency physician. This study aimed to compare the PSA characteristics of remifentanil with propofol/fentanyl combination.
Methods: In this double-blind randomized clinical trial, the procedural characteristics and number of failures, as well as adverse events were compared between groups treated with either remifentanil or propofol/fentanyl combination consisting of 15-60 year old patients referring to emergency department following acute anterior shoulder dislocation.
Results: 64 patients were randomly assigned to either remifentanil (32 cases) or propofol/fentanyl, (32 cases) groups. The two groups were similar regarding mean age, sex, and pain severity at the time of presentation to ED. The two regimens had the same efficiency regarding pain management (100% success rate). 22 (68.8%) cases in remifentanil group and 4 (12.5%) cases in propofol/fentanyl group had failed in muscle relaxation (p < 0.001). In the group receiving remifentanil, onset of action (p = 0.043) and recovery time (p < 0.001) were significantly shorter. 10 (31.3%) cases in remifentanil group and 11 (34.4%) cases in the other group experienced adverse events (p =0.790). There was a significant difference between groups regarding the type of adverse events (p = 0.003).
Conclusion: Compared to propofol/fentanyl combination, remifentanil has equal efficiency in pain management, lower success rate in muscle relaxation, significantly higher frequency of apnea, and shorter onset of action and recovery times in PSA for reduction of anterior shoulder dislocation.
- Propofol
- remifentanil
- fentanyl
- shoulder dislocation
How to Cite
References
Zacchilli MA, Owens BD. Epidemiology of shoulder dislocations presenting to emergency departments in the United States. JBJS. 2010;92(3):542-9.
Gharavifard M, Tafakori A, Zamani Moghadam H. Remifentanil versus Fentanyl/Midazolam in Painless Reduction of Anterior Shoulder Dislocation; a Randomized Clinical Trial. Emergency (Tehran, Iran). 2016;4(2):92-6.
Soysal S, Karcioglu O, Demircan A, Topacoglu H, Serinken M, Ozucelik N, et al. Comparison of meperidine plus midazolam and fentanyl plus midazolam in procedural sedation: a double-blind, randomized controlled trial. Advances in therapy. 2004;21(5):312-21.
Arhami Dolatabadi A, Mohammadian A, Kariman H. Lidocaine-Midazolam-Fentanyl Combination in Controlling Pain for Reduction of Anterior Shoulder Dislocation; a Randomized Clinical Trial. 2018. 2018;6(1).
Bassett KE, Anderson JL, Pribble CG, Guenther E. Propofol for procedural sedation in children in the emergency department. Annals of emergency medicine. 2003;42(6):773-82.
Miner JR, Burton JH. Clinical practice advisory: emergency department procedural sedation with propofol. Annals of emergency medicine. 2007;50(2):182-7. e1.
Komatsu R, Turan A, Orhanâ€Sungur M, McGuire J, Radke O, Apfel C. Remifentanil for general anaesthesia: a systematic review. Anaesthesia. 2007;62(12):1266-80.
Scott LJ, Perry CM. Remifentanil: a review of its use during the induction and maintenance of general anaesthesia. Drugs. 2005;65(13):1793-823.
Dunn MJ, Mitchell R, Souza CD, Drummond G. Evaluation of propofol and remifentanil for intravenous sedation for reducing shoulder dislocations in the emergency department. Emergency medicine journal : EMJ. 2006;23(1):57-8.
Phillips WJ, Halpin J, Jones J, McKenzie K. Remifentanil for procedural sedation in the emergency department. Annals of emergency medicine. 2009;53(1):163.
Swann A, Williams J, Fatovich DM. Recall after procedural sedation in the emergency department. Emergency Medicine Journal. 2007;24(5):322-4.
Cok OY, Ertan A, Bahadir M. Remifentanil versus fentanyl in combination with midazolam for retrobulbar block in cataract surgery. Saudi medical journal. 2008;29(4):544-8.
Rai M, Parry T, Dombrovskis A, Warner O. Remifentanil target-controlled infusion vs propofol target-controlled infusion for conscious sedation for awake fibreoptic intubation: a double-blinded randomized controlled trial. British journal of anaesthesia. 2007;100(1):125-30.
Maltepe F, Kocaayan E, Ugurlu B, Akdeniz B, Guneri S. Comparison of remifentanil and fentanyl in anaesthesia for elective cardioversion. Anaesthesia and intensive care. 2006;34(3):353.
Ozkan G, Ince M, Eskin M, Erol G, Kadan M, Ozgur G, et al. Sedoanalgesia for cardioversion: comparison of alfentanil, remifentanil and fentanyl combined with propofol and midazolam: a prospective, randomized, double-blind study. Eur Rev Med Pharmacol Sci. 2016;20(6):1140-8.
Herregods LL, Bossuyt GP, De Baerdemaeker LE, Moerman AT, Struys MM, Den Blauwen NM, et al. Ambulatory electrical external cardioversion with propofol or etomidate. Journal of clinical anesthesia. 2003;15(2):91-6.
Karthikeyan S, Balachandran S, Cort J, Cross M, Parsloe M. Anaesthesia for cardioversion: a comparison of sevoflurane and propofol. Anaesthesia. 2002;57(11):1114-9.
Clarke AC, Chiragakis L, Hillman LC, Kaye GL. Sedation for endoscopy: the safe use of propofol by general practitioner sedationists. Medical journal of Australia. 2002;176(4):158-61.
- Abstract Viewed: 397 times
- PDF Downloaded: 204 times
- HTML Downloaded: 98 times
